Obtaining Patient-Reported Outcomes Electronically With “OncoFunction” in Head and Neck Cancer Patients During Aftercare

The disease and treatment of patients with head and neck cancer can lead to multiple late and long-term sequelae. Especially pain, psychosocial problems, and voice issues can have a high impact on patients’ health-related quality of life. The aim was to show the feasibility of implementing an electronic Patient-Reported Outcome Measure (PROM) in patients with head and neck cancer (HNC). Driven by our department’s intention to assess Patient-Reported Outcomes (PRO) based on the International Classification of Functioning during tumor aftercare, the program “OncoFunction” has been implemented and continuously refined in everyday practice. The new version of “OncoFunction” was evaluated by 20 head and neck surgeons and radiation oncologists in an interview. From 7/2013 until 7/2017, 846 patients completed the PROM during 2,833 of 3,610 total visits (78.5%). The latest software version implemented newly developed add-ins and increased the already high approval ratings in the evaluation as the number of errors and the time required decreased (6 vs. 0 errors, 1.35 vs. 0.95 min; p<0.01). Notably, patients had different requests using PRO in homecare use. An additional examination shows that only 59% of HNC patients use the world wide web. Using OncoFunction for online-recording and interpretation of PROM improved data acquisition in daily HNC patients’ follow-up. An accessory timeline grants access to former consultations and their visualization supported and simplified structured examinations. This provides an easy-to-use representation of the patient’s functional outcome supporting comprehensive aftercare, considering all aspects of the patient’s life

Medical Informatics

Information technology has been revolutionizing the everyday life of the common man, while medical science has been making rapid strides in understanding disease mechanisms, developing diagnostic techniques and effecting successful treatment regimen, even for those cases which would have been classified as a poor prognosis a decade earlier. The confluence of information technology and biomedicine has brought into its ambit additional dimensions of computerized databases for patient conditions, revolutionizing the way health care and patient information is recorded, processed, interpreted and utilized for improving the quality of life. This book consists of seven chapters dealing with the three primary issues of medical information acquisition from a patient's and health care professional's perspective, translational approaches from a researcher's point of view, and finally the application potential as required by the clinicians/physician. The book covers modern issues in Information Technology, Bioinformatics Methods and Clinical Applications. The chapters describe the basic process of acquisition of information in a health system, recent technological developments in biomedicine and the realistic evaluation of medical informatics

Quantifying Quality of Life

Describes technological methods and tools for objective and quantitative assessment of QoL Appraises technology-enabled methods for incorporating QoL measurements in medicine Highlights the success factors for adoption and scaling of technology-enabled methods This open access book presents the rise of technology-enabled methods and tools for objective, quantitative assessment of Quality of Life (QoL), while following the WHOQOL model. It is an in-depth resource describing and examining state-of-the-art, minimally obtrusive, ubiquitous technologies. Highlighting the required factors for adoption and scaling of technology-enabled methods and tools for QoL assessment, it also describes how these technologies can be leveraged for behavior change, disease prevention, health management and long-term QoL enhancement in populations at large. Quantifying Quality of Life: Incorporating Daily Life into Medicine fills a gap in the field of QoL by providing assessment methods, techniques and tools. These assessments differ from the current methods that are now mostly infrequent, subjective, qualitative, memory-based, context-poor and sparse. Therefore, it is an ideal resource for physicians, physicians in training, software and hardware developers, computer scientists, data scientists, behavioural scientists, entrepreneurs, healthcare leaders and administrators who are seeking an up-to-date resource on this subject

A Multi-Level Assessment of Healthcare Facilities Readiness, Willingness, and Ability to Adopt and Sustain Telehealth Services

Telehealth technologies are becoming more pervasive throughout the healthcare system as a way to provide services to patients that would otherwise have difficulty with access. Currently, little is known about the current state of telehealth use within clinics and hospital in the US. Most studies evaluating telehealth programs are feasibility or small patient outcome studies from one location. Utilizing a hybrid framework combining the levels of complex socio-technical systems with the theory of ready, willing and able. The theory of ready, willing, and able is founded on the basis that these three preconditions need to be met for a change in behavior to occur, such as adoption of telehealth technologies. Study 1 utilizes multiple national healthcare data sets to analyze the higher levels of organizational factors that are associated with US hospitals who are ready and willing to implement telehealth technologies but lack the ability. Providing insight to the factors that can facilitate the ability to adopt such innovations. Study 2 is a mixed methods study that evaluates clinic data from the state of Nebraska. The quantitative survey data was used to develop interview questions and determine the sample population. The qualitative interviews yielded several themes on barriers to implementing and sustaining telehealth services in Nebraska. These include lack of providers to network with and technology malfunction issues. Many clinics want to increase their telehealth programs but are lacking the ability to do so. Study 3 is a combination of two meta-analyses that evaluate the effect of telehealth programs on the QOL for cancer patients in treatment and cancer survivors who are no longer in active treatment. The effect of the telehealth interventions on survivors QOL is significantly increased compared to survivors in usual care. More needs to be done to standardize telehealth evaluation and connection processes. Positive patient outcomes and clinical benefits can strengthen the legitimacy of telehealth technologies as part of normal healthcare practice. Yet without accurate data, the benefits cannot be fully assessed. Innovation is outpacing policy and procedures, this needs to be amended to fully maximize the benefits of telehealth technologies in the healthcare system

Quantifying Quality of Life

Describes technological methods and tools for objective and quantitative assessment of QoL Appraises technology-enabled methods for incorporating QoL measurements in medicine Highlights the success factors for adoption and scaling of technology-enabled methods This open access book presents the rise of technology-enabled methods and tools for objective, quantitative assessment of Quality of Life (QoL), while following the WHOQOL model. It is an in-depth resource describing and examining state-of-the-art, minimally obtrusive, ubiquitous technologies. Highlighting the required factors for adoption and scaling of technology-enabled methods and tools for QoL assessment, it also describes how these technologies can be leveraged for behavior change, disease prevention, health management and long-term QoL enhancement in populations at large. Quantifying Quality of Life: Incorporating Daily Life into Medicine fills a gap in the field of QoL by providing assessment methods, techniques and tools. These assessments differ from the current methods that are now mostly infrequent, subjective, qualitative, memory-based, context-poor and sparse. Therefore, it is an ideal resource for physicians, physicians in training, software and hardware developers, computer scientists, data scientists, behavioural scientists, entrepreneurs, healthcare leaders and administrators who are seeking an up-to-date resource on this subject

Virtual models of care for people with palliative care needs living in their own home: A systematic meta-review and narrative synthesis.

Background: Access to palliative care in the community enables people to live in their preferred place of care, which is often home. Community palliative care services struggle to provide timely 24-h services to patients and family. This has resulted in calls for ‘accessible and flexible’ models of care that are ‘responsive’ to peoples’ changing palliative care needs. Digital health technologies provide opportunities to meet these requirements 24-h a day. Aim: To identify digital health technologies that have been evaluated for supporting timely assessment and management of people living at home with palliative care needs and/or their carer(s), and the evidence-base for each. Design: A systematic review of systematic reviews (‘meta-review’). Systematic reviews evaluating evidence for virtual models of palliative or end-of-life care using one or more digital health technologies were included. Systematic reviews were evaluated using the Risk of Bias Tool for Systematic Reviews. A narrative approach was used to synthesise results. Data sources:Medline, Embase, Web of Science, CINAHL and Cochrane Database of systematic reviews were searched for English-language reviews published between 2015 and 2020. Results: The search yielded 2266 articles, of which 12 systematic reviews met criteria. Sixteen reviews were included in total, after four reviews were found via handsearching. Other than scheduled telehealth, video-conferencing, or after-hours telephone support, little evidence was found for digital health technologies used to deliver virtual models of palliative care. Conclusions: There are opportunities to test new models of virtual care, beyond telehealth and/or video conferencing, such as 24-h command centres, and rapid response teams

MOBILE BASED SYMPTOM MANAGEMENT FOR PALLIATIVE CARE

The goal of palliative care is to improve the quality of life of terminally ill patients through the management of pain and other symptoms. Though the term `palliative care\u27 is well known in the developed world, it is relatively a new term in the developing world. According to WHO, each year 4.8 million people suffering from severe pain caused by cancer, fail to receive treatment due to lack of resources and other barriers. In this thesis we have elaborated on the challenges faced by the rural breast cancer (BC) patients of Bangladesh and a solution for their palliative care treatment. Although breast cancer is commonly thought of as a disease of the developed world, the WHO statistics show that 69% of all BC deaths occur in developing countries. Unlike western countries where 89% of the women have a survival rate of more than 5 years, most BC patients in Bangladesh die because the majority of cases are diagnosed in late stages. These patients need palliative care which is almost absent in rural Bangladesh. These issues show the desperate need of a low cost palliative care system solution for the terminally ill patients of the developing world. Based on detailed field studies, we have developed and deployed a mobile based remote symptom monitoring and management system named e-ESAS. Design of e-ESAS has evolved through continuous feedback from both the patients and doctors. e-ESAS is being used by 10 breast cancer patients to submit symptom values from their home for the last 10 months (Nov\u2711- Sep \u2712). Our results show how e-ESAS with motivational videos not only helped the patients to have a `dignified\u27 life but also helped the doctors to achieve the goals of palliative care. Also the analyzed results are shown in 4 categories to appropriately measure the contribution of e-ESAS in improving the QoL. This thesis also focuses on developing a mobile based pain intensity detection tool which is a first step in replacing the manual paper based scale for measuring pain. The tool also might play a big role in assessing the pain level of verbally impaired patients

Grounds for a New Normal: Integration of Telenephrology in Rural Communities

Patients with kidney disease represent a group of people who are known to have comorbidities, high costs of care, decreased quality of life, and invasive interventions. In rural communities of Western Washington State, many nephrology patients experience factors evidenced to impede access to quality and timely management of their disease, compounding the risk for poor outcomes. Telenephrology is a novel modality of service delivery with the potential to make care more efficient, cost-effective, flexible, and accessible. The author created this project to develop a telenephrology program plan and evaluation for rural settings in Western Washington, informed by relevant epidemiology, pathophysiology, standards of care, and evidence in the literature. As there are a paucity of program plans specific to this service delivery in rural Western Washington, development of this project aims to substantiate the need for evidence-based implementation in this setting. The appraisal of barriers to care for this patient population was used to guide aspects of telenephrology program planning and evaluation to ensure intervention outcomes are equitable. This project provides grounds to support the adoption a new normal for nephrology care and utilizes the existing evidence to inform the planning and evaluating of telenephrology services, implementation processes, budget, and outcomes to assist healthcare providers and their institutions in successful integration of telenephrology in rural communities of Western Washington State